Comparative analysis of the therapeutic effect of antibiotic bone cement on Wagner grade 3 or 4 diabetic foot ulcer in heel and non-heel areas: a retrospective cohort study

Early human evidence such as case series or small samples is exploring possible benefits.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Background Heel diabetic foot ulcers (hDFU) represent a particularly severe form of DFU, characterized by prolonged healing times and a significantly elevated risk of major amputation. Effective strategies to control infection and improve outcomes in this high-risk population are urgently needed. While antibiotic bone cement (ABC) has emerged as a promising therapy for general DFU, its specific efficacy for hDFU remains unverified. This study aims to evaluate the clinical efficacy of ABC-based management for hDFU compared to non-heel DFU (nhDFU) and to identify risk factors for major amputation. Methods We conducted a retrospective cohort study of 77 patients with severe (Wagner grade 3 or 4) DFUs treated with an ABC protocol. Patients were stratified into hDFU (n=35) and nhDFU (n=42) groups. Propensity score matching (PSM) was used to balance baseline characteristics. Outcomes included major amputation rates, length of stay (LOS), infection control [measured by white blood cell (WBC) count], and risk factors analyzed via modified Poisson regression. Results At baseline, the hDFU group presented with greater disease severity, evidenced by significantly lower albumin levels (29.56 ± 6.45 g/L vs. 32.49 ± 5.25 g/L, P = 0.03) and higher WBC counts (Median: 14.86 vs. 10.32 × 10 9 /L, P = 0.002). After PSM, the major amputation rate was not significantly different between the hDFU an

Evidence level

Early human evidence such as case series or small samples is exploring possible benefits.

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